2024-11-12T12:34:09-06:00 2023-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-01-01 452633920 QUARTZ HEALTH PLAN MN CORPORATION QUAR 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 JEFFREY A BUTCHER SENIOR VP, CFO AND TREASURER 6084714771 2024-11-12 1 1 TROY MARINE CPA P00187863 4147775500 2024-11-06 2023 2024-10-15 13:58:12Z CHRISTINE C SENTY 2650 NOVATION PKWY FITCHBURG WI 53713 44268496 0 X WWW.QUARTZBENEFITS.COM X 2011 MN TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. 6 4 0 6 0 0 0 0 38818073 43747329 84392 521167 0 0 38902465 44268496 0 0 0 0 1193030 1339577 0 0 0 37683140 42350198 38876170 43689775 26295 578721 18352476 19664103 9973733 10688717 8378743 8975386 X TO PROMOTE SOCIAL WELFARE BY OPERATION OF A HEALTH MAINTENANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO, AND ANY OTHER LAWFUL ACTIVITY WITHIN THE PURPOSE FOR WHICH A CORPORATION MAY BE ORGANIZED UNDER THE MINNESOTA NONPROFIT CORPORATION ACT, SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND THE MINNESOTA HEALTH MAINTENANCE ACT. 0 0 40863348 43747329 TO PROMOTE SOCIAL WELFARE BY OPERATION OF HEALTH MAINTENANCE ORGANIZATION PROVIDING COMPREHENSIVE HEALTH CARE INSURANCE AND OTHER HEALTH CARE ACTIVITIES FOR 5,859 MINNESOTA MEMBERS UNDER THE MINNESOTA NONPROFIT CORPORATION ACT, SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE AND THE MINNESOTA HEALTH MAINTENANCE ACT. 40863348 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 250 0 1 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JEFFREY A BUTCHER 6084714771 2650 NOVATION PKWY FITCHBURG WI 53713 MARK J SELNA MD PRESIDENT & CEO (TERM 05/2023) 2.00 48.00 X X 0 810251 37104 CHRISTINE C SENTY JD PRESIDENT & CEO 2.00 48.00 X X 0 571762 46696 CHARLES L JOHNSON BOD - MEMBER 1.00 48.00 X 0 0 0 CHRISTINA BRENNAN OTT BOD - MEMBER 1.00 48.00 X 0 0 0 ROBERTA J HAUGAN BOD - MEMBER 1.00 0.00 X 0 0 0 STACEY L MOUNCE ARNOLD BOD - MEMBER 1.00 0.00 X 0 0 0 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 2.00 48.00 X 0 650584 35818 DAVID S HANEKOM MD SENIOR VP & CHIEF MEDICAL OFFICER 2.00 48.00 X 0 540460 48240 JAMES L HIVELEY VP, TREASURER & CFO (TERM 04/2023) 2.00 48.00 X 0 517354 23113 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 2.00 48.00 X 0 272239 38955 JAMI J BERGER SR VP CHIEF CLINICAL OFFICER (AS OF 11/2023) 2.00 48.00 X 0 78958 0 0 3441608 229926 0 0 1 0 GUNDERSEN LUTHERAN MEDICAL CENTER PO BOX 4444 LA CROSSE WI 54602 MEDICAL SERVICES 21201693 MEDIMPACT HEALTHCARE SYSTEMS 10181 SCRIPPS GATEWAY COURT SAN DIEGO CA 92131 MEDICAL SERVICES 10371458 WINONA HEALTH SERVICES 855 MANKATO AVE WINONA MN 55987 MEDICAL SERVICES 3944384 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1900 SOUTH AVE LA CROSSE WI 54601 MEDICAL SERVICES 3493828 OLMSTED MEDICAL CENTER 210 9TH ST SE ROCHESTER MN 55904 MEDICAL SERVICES 2228805 17 PREMIUM REVENUE 524114 43747329 43747329 43747329 521167 521167 44268496 43747329 0 521167 1036831 356089 680742 32568 11696 20872 198872 5139 193733 71306 27105 44201 19068 19068 41560 41560 41101 41101 90634 3854 86780 61685 6222 55463 420770 196887 223883 40200 40200 8834 1839 6995 4400 690 3710 2716 2716 38421 722 37699 28018 28018 MEDICAL EXPENSES 39818827 39818827 COMMISSIONS 602653 602653 OUTSOURCED SERVICES 593488 416865 176623 REGULATORY ACA FEES 343835 343835 193988 14697 179291 43689775 40863348 2826427 0 12593116 12965829 0 278141 4350392 4749744 549027 291406 859941 1378983 18352476 19664103 4999920 5140212 469475 433821 4504338 5114684 9973733 10688717 X 0 0 7950000 7950000 428743 1025386 8378743 8975386 18352476 19664103 X 578721 10855 7067 X X 0 1 X 1 0 0 DUE FROM QUARTZ HEALTH SOLUTIONS, INC. 28224 DUE FROM QUARTZ HEALTH BENEFIT PLANS CORPORATION 33936 REINSURANCE RECEIVABLE 1227956 DUE FROM QUARTZ HEALTH PLAN CORPORATION 78171 INVESTMENT INCOME ACCRUED 10696 1378983 PPACA PAYABLE 4546846 DUE TO QUARTZ HEALTH SOLUTIONS, INC. 499218 DUE TO QUARTZ HEALTH BENEFIT PLANS CORPORATION 53130 STATE DEFERRED TAX LIABILITY 11075 ESCHEAT PAYABLE 4415 5114684 X 44279351 10855 10855 44268496 0 44268496 43682708 -7067 -7067 43689775 0 43689775 PART X, LINE 2: QUARTZ HEALTH PLAN CORPORATION (QHPC) AND QUARTZ HEALTH PLAN MN CORPORATION (QHPMC) ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501( C )(4) OF THE INTERNAL REVENUE CODE. QHPC IS SUBJECT TO WISCONSIN STATE FRANCHISE TAX, ILLINOIS INCOME TAX, ILLINOIS RETALIATORY TAX, AND IOWA PREMIUM TAX. QHPMC IS SUBJECT TO MINNESOTA PREMIUM TAX. QUARTZ RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. FOR TAX POSITIONS MEETING THE MORE-LIKELY-THAN-NOT THRESHOLD, THE AMOUNT RECOGNIZED IN THE FINANCIAL STATEMENTS IS THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT WITH THE RELEVANT TAX AUTHORITY. QUARTZ HAS APPLIED THE UNCERTAIN TAX POSITION GUIDANCE TO ALL TAX POSITIONS FOR WHICH STATUTE OF LIMITATIONS REMAIN OPEN. QUARTZ RECOGNIZES, IF NECESSARY, INTEREST AND PENALTIES RELATED TO INCOME TAXES THAT HAVE BEEN ACCRUED OR RECOGNIZED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. PART XII, LINE 2D - OTHER ADJUSTMENTS: RX REBATE ADJUSTMENT ADDED FOR STAT -7,067. 1 1 0 0 0 0 0 0 0 MARK J SELNA MD PRESIDENT & CEO (TERM 05/2023) 0 275095 0 179925 0 355231 0 11154 0 25950 0 847355 0 0 JEFFREY A BUTCHER SENIOR VP, TREASURER & CFO 0 379608 0 176057 0 94919 0 12072 0 23746 0 686402 0 0 CHRISTINE C SENTY JD PRESIDENT & CEO 0 485829 0 52629 0 33304 0 13200 0 33496 0 618458 0 0 DAVID S HANEKOM MD SENIOR VP & CHIEF MEDICAL OFFICER 0 460111 0 76685 0 3664 0 13200 0 35040 0 588700 0 0 JAMES L HIVELEY VP, TREASURER & CFO (TERM 04/2023) 0 189501 0 50989 0 276864 0 4688 0 18425 0 540467 0 74823 KRISTIE S BREUNIG JD GENERAL COUNSEL, VP & SECRETARY 0 204156 0 67387 0 696 0 8273 0 30682 0 311194 0 0 PART I, LINE 3 QUARTZ HEALTH PLAN MN CORPORATION RELIED ON A RELATED ORGANIZATION, QUARTZ HEALTH SOLUTIONS, INC., THAT USED METHODS DESCRIBED BELOW TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION. - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B PART I, LINE 4A: SOME EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDER YEAR. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. PART I, LINE 4B: QUARTZ HEALTH SOLUTIONS, INC. INITIATED A NONQUALIFIED DEFERRED RETIREMENT PLAN IN 2019 AND STARTED FUNDING IN 2020. A NUMBER OF EMPLOYEES PARTICIPATED IN THE PLAN DURING THE YEAR. THE DEFERRED AMOUNT IS INCLUDED IN PART VII, COLUMN F AND SCHEDULE J, PART II, COLUMN C AND THE VESTED AMOUNT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN B(III). THE TERMS AND CONDITIONS OF THE CONFIDENTIAL AGREEMENTS ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. THE AMOUNT PAID TO JAMES L. HIVELEY DURING 2023 WAS $150,308. THERE WERE NO AMOUNTS PAID OUT TO ANY OTHER PARTICIPANTS. FORM 990, PART V, LINE 2B: ALL EMPLOYEES ARE LEGAL EMPLOYEES OF QUARTZ HEALTH SOLUTIONS (FEIN: 46-5710709), WHICH FILES ALL REQUIRED FEDERAL EMPLOYMENT FORMS EACH YEAR. FORM 990, PART VI, SECTION A, LINE 6 QUARTZ HEALTH PLAN CORPORATION IS THE SOLE CORPORATE MEMBER OF THIS ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER, QUARTZ HEALTH PLAN CORPORATION, ELECTS THREE MEMBERS OF THE BOARD OF DIRECTORS. THE REMAINING THREE MEMBERS OF THE BOARD ARE NOMINATED AND ELECTED BY THE ENROLLEES OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS ARE RESERVED TO THE SOLE CORPORATE MEMBER, QUARTZ HEALTH PLAN CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY BAKER TILLY US, LLP AND IS REVIEWED FOR COMPLETENESS AND ACCURACY BY MANAGEMENT. FOR THIS PURPOSE, MANAGEMENT INCLUDES THE CFO FOR QUARTZ HEALTH SOLUTIONS, INC. THE ORGANIZATION INFORMS THE MEMBERS OF THE BOARD FINANCE COMMITTEE THAT A COPY OF FORM 990 IS AVAILABLE FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND OFFICERS MUST REVIEW, COMPLETE, AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON AN ANNUAL BASIS. ALL DISCLOSURES ARE TRACKED AND HOUSED IN THE COMPLIANCE DEPARTMENT. FURTHER, IF AT ANY TIME AN INDIVIDUAL BECOMES AWARE OF AN ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST, THE POLICY INDICATES THAT THE INDIVIDUAL SHALL IMMEDIATELY NOTIFY THE COMPLIANCE OFFICER WHO THEN REVIEWS ANY DISCLOSED CONFLICTS TO ASSESS ANY RISK AND/OR NEGATIVE INFLUENCE ON THE HEALTH PLAN AND DRAFTS PROPOSED RECOMMENDATIONS TO ANY DISCLOSED CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER THEN PROVIDES THE DISCLOSED CONFLICTS OF INTEREST(S) AND PROPOSED RECOMMENDATION(S) TO A CONFLICT OF INTEREST REVIEW GROUP FOR FINAL REVIEW AND DETERMINATION REGARDING THE RECOMMENDATION. ONCE THE CONFLICT OF INTEREST REVIEW GROUP MAKES ITS FINAL DETERMINATION WITH RESPECT TO THE RECOMMENDATION, THE COMPLIANCE OFFICER SHALL COMMUNICATE THE RECOMMENDATION TO THE EMPLOYEE AND, WHEN APPLICABLE, TO THE CHAIRPERSON OF ANY COMMITTEE WHICH MAY BE REFERENCED IN THE RECOMMENDATION. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT WHO THEN REVIEWS THE REQUESTS AND MAKES THE APPROPRIATE DOCUMENTS AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT ITSELF FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN IRC SECTION 6104(D). FORM 990, PART XI, LINE 9: RX REBATE ADJUSTMENT ADDED FOR STAT 7,067. FORM 990, PART XII, LINE 2C: AS OF MAY 2016, THE FILING ORGANIZATION UTILIZES QUARTZ HEALTH PLAN CORPORATION'S AUDIT COMMITTEE. FORM 990, PART X, LINE 33: THE ORGANIZATION HAS PREPARED THE FORM 990 IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP), BUT DOES NOT FOLLOW SFAS 117 (ASC 958). THE IRS DOES NOT REQUIRE REPORTING ACCORDING TO ASC 958. QUARTZ HEALTH PLAN CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391807071 HEALTH MAINTENANCE ORGANIZATION WI 501(C)(4) 0 QUARTZ HEALTH BENEFIT PLANS CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391450766 HEALTH MAINTENANCE ORGANIZATION WI N/A C 0 QUARTZ HOLDING COMPANY 2650 NOVATION PKWY FITCHBURG WI 53713 821728929 HOLDING COMPANY WI N/A C 0 QUARTZ HEALTH SOLUTIONS INC 2650 NOVATION PKWY FITCHBURG WI 53713 465710709 TPA WI N/A C 0 QUARTZ HEALTH INSURANCE CORPORATION 2650 NOVATION PKWY FITCHBURG WI 53713 391565691 INDEMNITY CORPORATION WI N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 QUARTZ HEALTH SOLUTIONS INC P 2390395 COST AND FEES